MEDICARE: MR. JARVIS AC WHEELER MSW,MPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	W460-421-87-310-0	FL

General Provider Information

NPI Number	:	1689921892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JARVIS AC WHEELER MSW,MPA

Provider Business Mailing Address
First Line	:	6209 WESTGATE DR APT 1110
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-7074
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3270 SUNTREE BLVD STE 101
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940-7540
Country	:	US
Telephone Number	:	321-610-7949
Fax Number	:	321-610-7947

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2012
Last Update Date	:	08/07/2012

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